Epidemic intelligence activities among national public and animal health agencies: a European cross-sectional study

Epidemic Intelligence (EI) encompasses all activities related to early identification, verification, analysis, assessment, and investigation of health threats. It integrates an indicator-based (IBS) component using systematically collected surveillance data, and an event-based component (EBS), using non-official, non-verified, non-structured data from multiple sources. We described current EI practices in Europe by conducting a survey of national Public Health (PH) and Animal Health (AH) agencies. We included generic questions on the structure, mandate and scope of the institute, on the existence and coordination of EI activities, followed by a section where respondents provided a description of EI activities for three diseases out of seven disease models. Out of 81 gatekeeper agencies from 41 countries contacted, 34 agencies (42%) from 26 (63%) different countries responded, out of which, 32 conducted EI activities. Less than half (15/32; 47%) had teams dedicated to EI activities and 56% (18/34) had Standard Operating Procedures (SOPs) in place. On a national level, a combination of IBS and EBS was the most common data source. Most respondents monitored the epidemiological situation in bordering countries, the rest of Europe and the world. EI systems were heterogeneous across countries and diseases. National IBS activities strongly relied on mandatory laboratory-based surveillance systems. The collection, analysis and interpretation of IBS information was performed manually for most disease models. Depending on the disease, some respondents did not have any EBS activity. Most respondents conducted signal assessment manually through expert review. Cross-sectoral collaboration was heterogeneous. More than half of the responding institutes collaborated on various levels (data sharing, communication, etc.) with neighbouring countries and/or international structures, across most disease models. Our findings emphasise a notable engagement in EI activities across PH and AH institutes of Europe, but opportunities exist for better integration, standardisation, and automatization of these efforts. A strong reliance on traditional IBS and laboratory-based surveillance systems, emphasises the key role of in-country laboratories networks. EI activities may benefit particularly from investments in cross-border collaboration, the development of methods that can automatise signal assessment in both IBS and EBS data, as well as further investments in the collection of EBS data beyond scientific literature and mainstream media. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-16396-y.


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This survey is in English language and it should take maximum of 60 minutes of your time.
Structure of the questionnaire:

Existence and organization of Epidemic intelligence.
General question concerning EI activities within your institution 2. Three identical sections of disease surveillance with more detailed questions about EI activities.
You will be provided a list of diseases in the beginning of each section.
We ask you to choose diseases that are monitored within your institution by EI activities and describe their surveillance in details.
Choose three diseases that you are most comfortable answering for.

End of the questionnaire.
Some additional questions and free space if you wish to clarify or comment something.

Additional information for the survey
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Please note that the numbering of the questions depends on the answers you choose and therefore might not be logical.
at THL (Finnish Institute for Health and Welfare) makela@thl.fi

Existence and organization of Epidemic Intelligence (EI) activities
In this Section, please describe the general characteristics of the EI activities conducted in your institution for early detection, monitoring and assessment of signals of infectious disease emergence Survey completed by: 1. Name/surname *The survey analysis will be conducted anonymously. Collection of your name is only required to contact you for further information and to acknowledge your participation in future publications and reports.  Please note: Make sure that you will answer all the questions in this section based on activities with the disease you chose above.

Data sources for EI
In this section, please describe the data and sources you are monitoring as part of your EI activities, including the data and sources originating from both event-based and indicator-based surveillance. By captured information we mean verifying or validating the events that originate from unofficial verifying sources: cross-checking with official and/or reliable media sources to ensure that the event detected is from a reputable source, real and fully understood.

How does your institution collect, filter and verify information from the event-based sources for ? this disease
Manually (a fully human intervention based process for collection, filtering and verification) Semi-automatically (a combination of both automated processes and human intervention (E.g. for collection: automated information extraction from any of the above listed electronic sources (webscraping); for filtering: supervised machine learning approaches to classify information according to relevance, etc; and human-based verifying: trained experts confirming the authenticity of information, manual screening of above listed sources ) Automatically (a fully automated process for collection, filtering and verification of signals, without any human intervention (i.e. no manual processes involved).

7.1.
Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures (collection, filtering and verification) please list methodology/ models used,

etc.) software employed
Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

For signals from sources (IBS) indicator-based is the collection, analysis and interpretation of verified and structured
Indicator-based surveillance (IBS) epidemiological data from routine surveillance sources (e.g., active and passive disease surveillance systems)

By of indicators we mean the collection of indicator-based surveillance data for the early capturing
detection and monitoring of potential health hazards, which are related to outbreaks or incidents involving emerging infectious diseases.

By
we mean assessing the significance of the data. E.g. through statistical analysis and interpretation comparison with baseline rates or thresholds to determine if the indicator is relevant and relates a potential health hazard.

How does your institution capture, analyze and interpret information from the indicator-based sources for this disease?
Semi-automatically (a combination of both automated processes and human intervention (e.g. for collection: routine automated collection of indicators from health data; for analysis: automatic detection of clusters, patterns or trends in data using statistical methodology; generation of automatic alerts using estimated pre-defined thresholds; or routine model-based epidemic forecasting, etc; followed by humanbased interpretation: trained experts assessing whether an alert may arise from artefacts in the data) Automatically (a fully automated process for the collection, analyses and interpretation of signals, without any human intervention (i.e. no manual processes involved) 8.1. Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures, please list etc.) methodology/ models used, software employed Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

Assessment of signals (information from both EBS and IBS)
9. How does your institution define a signal requiring assessment regarding ? this disease The is made, following analysis and interpretation of both IBS and EBS signals, to estimate the risk associated with the assessment signal that has been detected.

Semi-automatically
Manually: Expert review of signal Assessment done: 9.1. Can you describe the process with ? What are the processes leading to action or further this disease investigation? Please note: Make sure that you will answer all the questions in this section based on activities with the disease you chose above.

Data sources for EI
In this section, please describe the data and sources you are monitoring as part of your EI activities, including the data and sources originating from both event-based and indicator-based surveillance.   By captured information we mean verifying or validating the events that originate from unofficial verifying sources: cross-checking with official and/or reliable media sources to ensure that the event detected is from a reputable source, real and fully understood.

Manually (a fully human intervention based process for collection, filtering and verification)
Semi-automatically (a combination of both automated processes and human intervention (E.g. for collection: automated information extraction from any of the above listed electronic sources (webscraping); for filtering: supervised machine learning approaches to classify information according to relevance, etc; and human-based verifying: trained experts confirming the authenticity of information, manual screening of above listed sources ) Automatically (a fully automated process for collection, filtering and verification of signals, without any human intervention (i.e. no manual processes involved).

7.1.
Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures (collection, filtering and verification), please list methodology/ models used,

etc.) software employed
Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

For signals from sources (IBS) indicator-based is the collection, analysis and interpretation of verified and structured
Indicator-based surveillance (IBS) epidemiological data from routine surveillance sources (e.g., active and passive disease surveillance systems)

By of indicators we mean the collection of indicator-based surveillance data for the early capturing
detection and monitoring of potential health hazards, which are related to outbreaks or incidents involving emerging infectious diseases.

By
we mean assessing the significance of the data. E.g. through statistical analysis and interpretation comparison with baseline rates or thresholds to determine if the indicator is relevant and relates a potential health hazard.

How does your institution capture, analyze and interpret information from the indicator-based sources for this disease?
Semi-automatically (a combination of both automated processes and human intervention (e.g. for collection: routine automated collection of indicators from health data; for analysis: automatic detection of clusters, patterns or trends in data using statistical methodology; generation of automatic alerts using estimated pre-defined thresholds; or routine model-based epidemic forecasting, etc; followed by humanbased interpretation: trained experts assessing whether an alert may arise from artefacts in the data) Automatically (a fully automated process for the collection, analyses and interpretation of signals, without any human intervention (i.e. no manual processes involved) 8.1. Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures, please list etc.) methodology/ models used, software employed Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

How does your institution define a signal requiring assessment regarding ? this disease
The is made, following analysis and interpretation of both IBS and EBS signals, to estimate the risk associated with the assessment signal that has been detected.

Semi-automatically
Manually: Expert review of signal Assessment done: 9.1. Can you describe the process with ? What are the processes leading to action or further this disease investigation?

International EI collaboration
The following section will address the existence international collaboration and the cross-collaboration of the EI systems.

11.
Is there any collaboration with neighbouring countries or international structures (e.g., WHO, FAO, ECDC) regarding ? this disease Collaboration on the level of e.g. surveillance design, data collection, data sharing, data analyses, data management etc.

Yes
No 11.1. In which of the following sections does the collaboration take place? Tick all that applies Please note: Make sure that you will answer all the questions in this section based on activities with the disease you chose above.

Data sources for EI
In this section, please describe the data and sources you are monitoring as part of your EI activities, including the data and sources originating from both event-based and indicator-based surveillance.

2.
What is the geographical scope of interest of the Epidemic Intelligence activities conducted in your institute regarding ? this disease

Please choose one option from each row Event-based surveillance (EBS) is the capturing, filtering and verification of non-structured epidemiological data from a variety of informal sources (e.g., social media & electronic media news monitoring).
Indicator-based surveillance (IBS) is the collection, analysis and interpretation of verified and structured epidemiological data from routine surveillance sources (e.g., active and passive disease surveillance systems).

Tick all that applies
Event-based surveillance (EBS) is the capturing, filtering and verification of non-structured epidemiological data from a variety of informal sources (e.g., social media & electronic media news monitoring).  By captured information we mean verifying or validating the events that originate from unofficial verifying sources: cross-checking with official and/or reliable media sources to ensure that the event detected is from a reputable source, real and fully understood. 7. How does your institution collect, filter and verify information from the event-based sources for ? this disease Manually (a fully human intervention based process for collection, filtering and verification) Semi-automatically (a combination of both automated processes and human intervention (E.g. for collection: automated information extraction from any of the above listed electronic sources (webscraping); for filtering: supervised machine learning approaches to classify information according to relevance, etc; and human-based verifying: trained experts confirming the authenticity of information, manual screening of above listed sources ) Automatically (a fully automated process for collection, filtering and verification of signals, without any human intervention (i.e. no manual processes involved).

7.1.
Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures (collection, filtering and verification), please list methodology/ models used,

etc.) software employed
Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

For signals from sources (IBS) indicator-based is the collection, analysis and interpretation of verified and structured
Indicator-based surveillance (IBS) epidemiological data from routine surveillance sources (e.g., active and passive disease surveillance systems) By of indicators we mean the collection of indicator-based surveillance data for the early capturing detection and monitoring of potential health hazards, which are related to outbreaks or incidents involving emerging infectious diseases.

By
we mean assessing the significance of the data. E.g. through statistical analysis and interpretation comparison with baseline rates or thresholds to determine if the indicator is relevant and relates a potential health hazard. 8. How does your institution capture, analyze and interpret information from the indicator-based sources for this disease?
Semi-automatically (a combination of both automated processes and human intervention (e.g. for collection: routine automated collection of indicators from health data; for analysis: automatic detection of clusters, patterns or trends in data using statistical methodology; generation of automatic alerts using estimated pre-defined thresholds; or routine model-based epidemic forecasting, etc; followed by humanbased interpretation: trained experts assessing whether an alert may arise from artefacts in the data) Automatically (a fully automated process for the collection, analyses and interpretation of signals, without any human intervention (i.e. no manual processes involved) 8.1. Please shortly describe the process with emphasis on the tools and software used (i.e. for each of the three procedures, please list etc.) methodology/ models used, software employed Please note: This is an important question for us to understand the overall process. We kindly ask you to provide short overview of the process and tools used

Assessment of signals (information from both EBS and IBS)
9. How does your institution define a signal requiring assessment regarding ? this disease The is made, following analysis and interpretation of both IBS and EBS signals, to estimate the risk associated with the assessment signal that has been detected.

Semi-automatically
Manually: Expert review of signal Assessment done: 9.1. Can you describe the process with ? What are the processes leading to action or further this disease investigation?